BATON ROUGE, La. — The ambitious liver would go anywhere in his home state to administer the hepatitis B vaccine.
Bill Cassidy offered jabs to thousands of inmates at Louisiana’s maximum-security prison in the early 2000s. A decade before that, he set up vaccination clinics in high schools, a model hailed nationally as a success.
“He managed to immunize that entire generation in East Baton Rouge,” said Holley Galland, a retired doctor who worked with Cassidy vaccinating schoolchildren.
Around the same time, a lawyer and environmental activist with a famous last name was beginning to build the loyal anti-vaccine coalition that, two decades later, would prompt President Donald Trump to nominate him as the nation’s top health official.
Today, one year after the now senator. Cassidy cautiously cast the vote that secured Robert F. Kennedy Jr.’s elevation to that office, the Louisiana Republican’s life’s work — in medicine and politics — is unraveling.
Hepatitis B vaccination rates for newborns in the U.S. had plummeted to 73% in August, down 10 percentage points from the peak in February 2023, according to research published in JAMA last month. In December, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (reformed by Kennedy) voted to repeal a two-decade-old recommendation that all newborns receive the vaccine.
The following month, Trump endorsed U.S. Rep. Julia Letlow, a rival of Cassidy in what is shaping up to be a competitive Republican Senate primary. Letlow’s foray into politics began in 2021 when she took the seat won by her husband, which was left vacant after his death from Covid.
KFF Health News requested multiple comments from Cassidy over three months. His staff declined to make him available for an interview or comment. Letlow’s campaign did not respond to requests for comment.
The rise of the skeptics
As the May primary approaches, some Louisiana doctors worry they have begun a long, dark road when it comes to vaccine-preventable diseases.
Last year, on the day Kennedy was sworn in a thousand miles away in Washington, Louisiana’s health department stopped promoting vaccines, stopping its clinics and its advertising. Their communications about an ongoing whooping cough outbreak in the state have all but ceased. It took months until the state announced last year that two babies had died from the disease. A Louisiana child was confirmed dead from the flu in January, and a pair of measles cases were reported last year.
Spokespeople for the Louisiana Department of Health did not respond to questions.
“It’s very difficult to see children get sick from diseases that they should never have gotten in the first place,” said Mikki Bouquet, a Baton Rouge pediatrician. “You just want to scream into the emptiness of this community for how they failed this child.”
As anti-vaccine forces took over state and federal health departments, Cassidy lamented the consequences.
“Families are getting sick and people are dying from vaccine-preventable causes, and that tragedy must stop,” he wrote on social media last fall.
But while it is Cassidy’s duty as chairman of the Senate Health, Education, Labor and Pensions Committee to oversee the health department, Kennedy has appeared before the committee only once since he was confirmed.
The secretary speaks at a “normal” pace with Cassidy, said Department of Health and Human Services spokesman Andrew Nixon.
Kennedy’s department has elevated vaccine skeptics in Louisiana. The state surgeon general who ended Louisiana’s vaccination campaign, Ralph Abraham, was named deputy director of the CDC. (He left office in February). And Kennedy hand-picked Evelyn Griffin, a Baton Rouge obstetrician-gynecologist who later replaced Abraham as the state’s surgeon general, for an appointment to the ACIP. Griffin has suggested that the Covid vaccine had dangerous side effects for young patients.
Research has shown that serious side effects from vaccines are rare and that vaccines saved millions of lives during the pandemic.
Cassidy “hasn’t really had an open chorus of policy supporters” when it comes to getting people vaccinated, said Michael Henderson, a professor of political communication at Louisiana State University. “There’s not much political stake in doing that in Louisiana if you’re a Republican.”
Louisiana Gov. Jeff Landry rebuked Cassidy after the senator called on the state health department to facilitate access to Covid vaccines.
“Why don’t you leave a prescription for the dangerous Covid vaccine at your district office and anyone can stop by and get one?” the Republican joked about X in September.
About ‘eggshells’ in the exam room
On a sunny February afternoon, as Carnival floats prepared to parade through the streets of New Orleans, pediatrician Katie Brown approached a basement apartment on a well-child visit. Cowboy boot pendants hung from his ears and a package of diapers was clutched tightly in his arms.
The patient, a little girl who waved when she saw visitors, was up to date on her vaccinations. But when Brown suggested a Covid vaccine, the girl’s mother quickly declined, pointing out that she had never received the vaccine either.
Many of Brown’s young patients, seen through Nest Health, which offers home visits covered by Louisiana’s Medicaid program, are up to date on their vaccines. Brown said home visits make parents feel more comfortable vaccinating their children, but he still spends more time these days explaining what they’re getting with those vaccines.
“After the Covid vaccines, that’s when some people just decided, ‘I don’t know if I trust the vaccines, period,’” he said.
Statewide, vaccination rates have declined since the pandemic, below levels scientists say are necessary to achieve herd immunity against some deadly diseases, including measles. About 92% of Louisiana kindergartners have received the recommended two doses of the measles, mumps and rubella vaccine.
The New Orleans Health Department has tried to ramp up its own $100,000 immunization campaign, with clinics and billboards, during this year’s flu season, said Jennifer Avegno, the department’s director.
But the absence of the State is felt. Other Louisiana parishes have not taken similar steps, leaving doctors largely alone to promote vaccinations.
“I’ll say it for sure,” Avegno said. “It has been a hard blow not to have coordination at the state level.”
A day after Brown’s home visit, a mother in Baton Rouge shook her head when Bouquet offered her 10-year-old daughter a flu shot in an exam room.
In the waiting room, parents can flip through a handmade book that offers scientific facts to counter fears about vaccines. A laminated guide posted in each exam room explained the benefits of each recommended vaccine.
Bouquet said she is experimenting with ways to educate parents about vaccines without seeming overbearing. He has not yet found a safe formula. Some parents now shut down any discussion about vaccines, and she worries that others will skip scheduling appointments to avoid the topic altogether.
“We have to walk on eggshells a little bit to figure out how to regain that trust,” Bouquet said. “And perhaps these discussions can come up in future visits.”
Pro-Vax, Pro-Anti-Vaxxer
Children’s Health Defense, the nonprofit Kennedy led, worked to erode trust in vaccines during the pandemic, falsely claiming, for example, that Covid shots cause organ damage and that polio vaccines were to blame for the rise in the disease. The organization also sued the federal government over mRNA-based Covid shots, hoping to have their Food and Drug Administration emergency authorizations revoked.
When Kennedy appeared before Cassidy’s committee in January 2025 as Trump’s nominee for health secretary, the senator and doctor saw risks if the prominent anti-vaccine lawyer was confirmed.
Cassidy described a time years ago when he put an 18-year-old man on a helicopter to receive an emergency liver transplant. The young woman suffered from acute hepatitis B, an incurable disease that is transmitted mainly through blood or body fluids and can cause liver failure.
It was “the worst day of my medical career,” he said, addressing Kennedy at the witness table in front of him. “Because I thought $50 worth of vaccines could have prevented all of this.”
Cassidy entered politics in 2006 as a state senator and won election to the U.S. House of Representatives two years later. When he first ran for the U.S. Senate in 2014, he captivated Louisiana voters with campaign ads that showed him dressed in a medical gown and a white lab coat, talking about his work with Hurricane Katrina evacuees and patients at the Baton Rouge public hospital.
But some Republicans became angry with Cassidy after he voted to convict Trump on an article of impeachment accusing him of inciting the Jan. 6, 2021, insurrection at the U.S. Capitol.
The impeachment vote has hampered Cassidy’s re-election bid this year in a state where Trump won 60% of the vote in 2024.
“Cassidy has things associated with her name: the impeachment vote in 2021,” Henderson said.
Cassidy’s loyalty to Trump was tested again with Kennedy’s nomination. Cassidy said he was backing Kennedy after getting promises that he would not disrupt the country’s vaccination program.
But since taking office, Kennedy has largely ignored those promises and Cassidy has not publicly rebuked him.
Former Texas congressman Michael Burgess served for years with Cassidy in the House, where they were founding members of the GOP Physicians Caucus, started in 2009. He said Cassidy’s discomfort with some of Kennedy’s actions is palpable.
“You could hear some pain in Senator Cassidy’s voice when he said the secretary wanted to eliminate the hepatitis B birth dose,” Burgess said. “Hepatitis B cases reached almost zero. It was painful to think about taking this away from the population.”
Elizabeth Britton, a retired nurse practitioner from Baton Rouge, changed her party affiliation so she could vote in the close Republican primary for Cassidy, with whom she vaccinated inmates decades ago.
He doesn’t fully understand the “mess” in Washington that resulted in the senator voting to confirm a vaccine critic.
Watching Kennedy and others promulgate doubts about the injections she once administered has made her “deeply sad” and “angry,” she said, but mostly worried.
“My stomach is in knots, because I know the consequences of people not getting vaccinated,” he said.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF, an independent source of research, polling and health policy journalism. Learn more about KFF.
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